Indications: skin, hair, and mucosal mycoses that cannot be treated with other antifungals (including dermatophytoses, pityrosporum folliculitis, cutaneous candidiasis, chronic mucocutaneous candidiasis, oropharyngeal and oesophageal candidiasis, chronic recurrent vaginal candidiasis); systemic mycoses that cannot be treated with other antifungals (including histoplasmosis, blastomycosis, coccidioidomycosis, paracoccidiodomycosis.

Cautions: predisposition to adrenocortical insufficiency; avoid in porphyria

Potentially life-threatening hepatotoxicity very rarely; risk of hepatotoxicity greater if given for longer than 14 days. Monitor liver function before treatment, then on weeks 2 and 4 of treatment, then every month; in active liver disease; if history of hepatotoxicity with other drugs.

Contra-indications: hepatic impairment; breast-feeding.

Side Effects: nausea, vomiting, abdominal pain; pruritus; less commonly diarrhoea, headache, dizziness, drowsiness, and rash; very rarely fatal liver damage, dyspepsia, raised intracranial pressure, adrenocortical insufficiency, erectile dysfunction, menstrual disorders, oligospermia, gynaecomastia, thrombocytopenia, photophobia, and alopecia.

Dose: 200 mg once daily, increased if response inadequate to 400 mg once daily; continued until symptoms have cleared and cultures negative (usually for 4 weeks in dermatophytoses, 2–3 weeks for oral and cutaneous candidiasis, 1–2 months for hair infections); CHILD body-weight 15–30 kg, 100 mg once daily; body- weight over 30 kg, adult dose

Chronic, recurrent vaginal candidiasis, 400 mg once daily for 5 days.